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Arrhythmias & electrophysiologyCohort study

Durable burden suppression and recurrence patterns after cryoablation in early persistent atrial fibrillation (AF): 3-year results of COOL-PER trial

Heart RhythmPublished

  • prospective, multicenter, single-arm study
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Authors' conclusion

CBA achieved durable AF burden suppression over 3 years in early persistent AF. Subsequent recurrence after the first year was common and was predominantly detectable by ILR only. Subsequent recurrences were often paroxysmal, with a lower AF burden and associated with lower HCRU, supporting the value of continuous long-term rhythm monitoring for characterizing rhythm status beyond the first post-ablation year.

Study context

Population
Patients with early persistent AF (duration ≤ 3 years) undergoing cryoballoon ablation (CBA), with an implantable loop recorder (ILR) implanted 7–90 days before CBAenrolled, 123 completed the 3-year follow-up
Participants
130 patients

Main finding

As reported in the abstract

Median AF burden · baseline, 1, 2 and 3 years

Baseline

99.9% (interquartile range, 53.1-100.0)

1 year

0.1% (0.0-4.2)

2 years

0.5% (0.0-9.1)

3 years

0.7% (0.0-9.5)

Observational data: associations, not effects.

Further findings

Subsequent recurrence among the 47 patients recurrence-free at 1 year

Of 47 patients recurrence-free at 1 year, developed subsequent recurrence
25 (53.2%)
Of the 25 subsequent recurrences, detected by ILR alone
20 (80.0%)

Subsequent recurrence vs first-year recurrence

Persistent recurrence, subsequent vs first-year
4.0% vs 28.9%; P = .001
AF burden, subsequent vs first-year
0.1% [0.0-1.6] vs 2.8% [0.4-18.7]; P = .010

Additional rhythm control interventions and cardiovascular hospitalization by persistent-type recurrence and by AF burden ≥ 10%

Additional rhythm control interventions, persistent-type recurrence
78.3% vs 30.8% vs 0%
Additional rhythm control interventions, AF burden ≥ 10%
78.6% vs 39.1% vs 0%
Cardiovascular hospitalization, persistent-type recurrence
17.4% vs 3.8% vs 0%, P = .045
Cardiovascular hospitalization, AF burden ≥ 10%
14.3% vs 4.3% vs 0%, P = .029
  • additional rhythm control interventions: both P < .001

Baseline characteristics of completers

mean age
60.5 ± 8.4 years
women
25.2%

Original publication

Durable burden suppression and recurrence patterns after cryoablation in early persistent AF: 3-year results of COOL-PER trial. Heart Rhythm. Published 29 August 2026. doi:10.1016/j.hrthm.2026.08.042
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Summarised from the published abstract; every number is checked against it